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Atropine administration
3%
1/35
Potassium and magnesium repletion
63%
22/35
Hemodialysis
9%
3/35
Cardiac catheterization
Cardiac pacemaker implantation
20%
7/35
Select Answer to see Preferred Response
Digoxin toxicity can present with nausea, vomiting, and decreased appetite in conjunction with a wide array of EKG changes. Treatment includes correcting electrolytes disturbances, especially potassium and magnesium repletion as necessary. Hypokalemia is a risk factor for digoxin toxicity due to competitive binding at the potassium site of the Na/K-ATPase pump. Causes of hypokalemia include loop diuretic use (as in this case) and excessive fluid losses associated with vomiting or diarrhea. Symptoms of digoxin toxicity include nausea, vomiting, blurry yellow vision, electrolyte abnormalities, and cardiac arrhythmias. While a wide array of EKG changes can occur with digoxin toxicity, increased PR intervals, decreased QT intervals, and T wave inversion are commonly seen. Management of digoxin toxicity involves slow normalization of potassium and magnesium levels and administration of antibody fragments (Fab) targeting digoxin. Figure A shows an EKG with progressively increasing PR intervals terminating in a non-conducted P wave, characteristic of a second-degree Mobitz I block. Incorrect Answers: Answer 1: Atropine is used for management of bradycardia in the setting of beta blocker overdose. This patient does not have signs of carvedilol toxicity. Atropine can also be used for digoxin toxicity if the patient was hemodynamically unstable and bradyarrhythmic. Answer 3: Hemodialysis is not recommended for management of digoxin toxicity. Answer 4: This patient has no acute indication for cardiac catheterization. Answer 5: Cardiac pacemaker implantation is indicated for management of second-degree Mobitz II block.
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